Group B Strep (GBS) in Pregnancy: What’s a Mom to Do?

It’s practically impossible to pick up a newspaper or magazine these days without coming across an article on the importance of a healthy microbiome for our overall health. If you’ve been educating yourself about the microbiome, you’ve probably learned that antibiotics are one of the things that can have a negative impact on it. You may have also read that when young babies are exposed to antibiotics, it can increase their risk for eczema, allergies, and asthma in childhood, and even obesity and diabetes later in life. So it’s understandable that pregnant moms, and even some health care professionals, are concerned about antibiotic overuse, and are questioning the wisdom of universally giving antibiotics preventatively in labor to women found to have GBS colonization during routine pregnancy testing. But as a mom, it’s a confusing decision – take the chance on the low likelihood of your baby developing a serious GBS infection if you don’t do the antibiotics in labor, or take an antibiotic that can harm baby’s microbiome.

This article answers the numerous questions real mommas have sent to me, explains what GBS is, reviews the risks to baby if untreated, and will discuss the validity and safety of some of the common GBS testing “hacks” being used in pregnancy, as well as alternative methods of prevention and treatment.

GBS is a complex issue, and while I can’t give you “the answer to what you should do,” because in truth, there is no one right answer, and much of what we know about the impact of antibiotics on the infant microbiome is still emerging, my hope is to give you enough information (this is a comprehensive blog!) to make the most educated decision possible that is also within your comfort zone.

What is GBS?

Let’s start with the basics in case you’re new to this issue. Group B Streptococcus (Streptococcus agalactiae), or GBS for short, is one of the trillions of organisms that normally inhabit the human intestinal tract. By migration from the intestines, it colonizes the rectum, bladder, and vaginal tracts of many women and can thus be identified in cultures of combined rectal and vaginal swab samples. GBS doesn’t seem to play a particularly beneficial role in human health, nor, when kept in check by healthy gut flora, does it usually cause harm. Colonization in the mother doesn’t mean you actually have an infection; it just means the bacteria are present, which is the case for about 15% to 30% of pregnant women.

What’s the Big Fuss?

When a pregnant woman is found to be colonized by GBS, as detected on lab tests, the risk goes up that she might pass the bacteria onto her baby. Most healthy babies will just develop their own colonization of the skin and gut as a result of contact with the mother’s vaginal flora, however, a small percentage who get exposed will become infected – meaning they get sick, some very sick, from the GBS – and that’s what the fuss is about.

In the 1970s GBS was recognized as a leading cause of serious infections in newborns including pneumonia, sepsis, and meningitis. Most bacterial transmission to the newborn occurs during birth via passage of the baby through the birth canal, or through bacteria that ascend the birth canal during a labor with ruptured membranes (broken “bag of waters”). Premature babies and babies of women with premature or prolonged rupture of membranes (PROM) are at higher risk of developing GBS infection. GBS can also cross the membranes, so cesarean section is not protective and carries additional surgical risks to the mother. In the pregnant mom, GBS can also cause miscarriage, bladder and uterine infections; it increases the risk of premature labor and premature rupture of membranes (PROM) and stillbirth.

If a pregnant women carrying GBS is not treated with antibiotics during labor, the baby’s risk of becoming colonized with GBS is approximately 50%. Note that most colonized babies do not develop GBS infection. The risk of a baby developing a serious, life-threatening GBS infection, according to the Centers for Disease Control and Prevention (CDC), is 1 to 2%.

The mortality rate (number of babies that die) with early onset GBS infection is 2 to 3% for full-term infants (I know that sounds low, but as I always tell my patients, it’s 100% if it’s your baby), and as high as 20-30% for premature infants (born earlier than 33 weeks gestation). Over 1600 cases of early-onset infections occur in newborns annually, with about 80 deaths per year, despite antibiotic prophylaxis in labor.

GBS infection in the newborn can lead to very long stays in the NICU (Neonatal Intensive Care Unit,) and up to 44% of infants who survive GBS meningitis end up with long-term health problems, including developmental disabilities, paralysis, seizure disorders, hearing loss, and vision loss.

If a GBS positive woman is treated with antibiotics during labor, her infant’s risk of developing early onset GBS infection decreases by about 80%. There are no statistics on the percentage of babies exposed to an early antibiotic that will develop short, or long-term consequences such as allergies, asthma, obesity, or diabetes.

How & When Does GBS Infection Occur in the Baby?

Infection is categorized in two ways, either early or late onset GBS infection. Symptoms of early-onset disease occur within a few hours of the birth, and up to a week after. In one large study, as cited by Rebecca Drekker, PhD of Evidence Based Birth, of 148,000 infants born between 2000 and 2008, nearly all of the 94 infants who developed early GBS infection were diagnosed within an hour after birth – suggesting that early onset GBS infection probably begins even before birth. Antibiotic prophylaxis (preventative treatment) given to the mother during labor is used to prevent early-onset infection.

Late-onset disease develops through contact with hospital nursery personnel and usually manifests in the first 3 months after birth. Up to 45% of health care workers carry the bacteria on their skin, and may transmit the infection to newborns. Meticulous hand-washing practices in the hospital are essential for prevention of infection transmission.

What Women Get GBS? & Which Babies Get GBS Infection?

While any woman can be colonized by GBS, some seem to be more at risk. This includes women under 20 years old, women with multiple sexual partners and regular tampon users. Frequent sex, or sex close to the time you get tested, oral sex (getting it, not giving it), and infrequent hand washing are also associated with a greater likelihood of a positive GBS test. For some reason I cannot explain, African-American women are also more likely to be colonized by GBS. New research coming out on the microbiome does suggest that disrupted gut microflora may play a role in GBS colonization. I discuss this in a minute.

While any baby can develop GBS infection if the mother is colonized, the following factors increase a baby’s risk: birth prior to 37 weeks, African-American descent, high temperature in the mom during labor, rupture of membranes before entering labor, a prolonged time between membrane rupture and birth, chorioamnionitis (infection of the membranous sac surrounding the baby), intrauterine monitoring during labor.

What Testing is Recommended & Is It Reliable?

The gold standard test used in screening for GBS is a bacterial culture of a sample collected from a simultaneous vaginal and rectal swab done by your obstetrician, family doctor, or midwife. The best time to test for the presence of the organism is between the 35th and 37th weeks of pregnancy. Testing at this time is as much as 50% more effective at predicting and preventing perinatal disease than screening earlier in pregnancy, although the numbers of organisms in any individual might fluctuate, making detectable levels variable. CDC guidelines published in 2002 recommend universal screening for pregnant mothers between 35 and 37 weeks gestation.

GBS is found in the urine of 2%-7% of pregnant women. A positive urine test for GBS in the first trimester, also a common diagnostic method, is a marker of heavy rectal and vaginal colonization with GBS in the mother, and is a risk factor for early onset GBS in the newborn. Thus it is considered an indication for antibiotic use in labor. Antibiotic treatment of GBS bacteriuria during pregnancy does not eliminate GBS from the genitourinary and gastrointestinal tracts, and recolonization after a course of antibiotics is typical, so this does not offset the recommendation that pregnant women with GBS in their urine receive antibiotics in labor.

The above testing is considered highly reliable when it comes to positive results – in other words, if you test positive, you’re colonized. Testing is done at 35-37 weeks of pregnancy, because there is a 5 week window of reliability – if you test positive, you’re still likely to be positive for the next five weeks, allowing proper prevention to be done in labor. A negative test, however, does not mean you do not have the infection; it could be what is called a “false negative” meaning that the test missed the infection. You can also become colonized after the test was done, so while your test could have been negative in pregnancy, you could in fact be positive at the time of labor. In fact, a substantial percentage of women who are ultimately GBS positive at the time of birth will not receive antibiotics because the presence of the bacteria was missed in pregnancy.

An FDA approved rapid test can diagnose GBS in pregnant women in about an hour. It is generally recommended for use only in labor when a woman’s GBS status is unknown and testing needs to be done rapidly for medical reasons such as premature rupture of membranes (PROM). Some studies have shown the test to be up to 91% sensitive, even more so than the 37-37 week culture, which catches about 69% of cases. Because GBS resistance to specific antibiotics has developed, especially to those used for penicillin-allergic women, culture and sensitivity testing is recommended as part of the testing process.

Should I Just Skip the Test So I Don’t Know if I’m Positive?

Skipping the test to avoid a positive result is one strategy many women ask me about and it’s something that many of my home birth midwifery clients chose to do. But here’s the thing: If you don’t know whether you are positive and you’re having your baby in the hospital, or have to transport from a home birth to the hospital with any risk factors for GBS including early broken waters, prolonged broken waters (> 18 to 24 hours depending on your midwifery or medical practice), or an elevated temperature, you’re still going to be prescribed the antibiotic. On the other hand, if you’ve been tested and have had a negative test result, then the antibiotic isn’t indicated and you’re sort of in the clear from the decision. So having a negative test result can actually be an advantage and can put your mind at ease if you’re worried about being GBS positive.

Further, if you are positive and know it, you can get educated about your decision, and will likely more mindful of signs of possible GBS infection in your baby, should you choose to forego the antibiotic. So while I am not saying everyone should get testing, simply declining the test to avoid knowing the results isn’t necessarily more effective for avoiding the antibiotic in labor. It’s sort of the same with gaming the test by using natural treatments for the few weeks before the test to achieve a negative test result – you might have just reduced the colonization so that it was low enough to give you a negative, but you might still be colonized at the time of birth and not know it.

What’s the Treatment & Is It Recommended for Me?

As of 2002, the CDC has recommended routine screening for all pregnant women between 35 and 37 weeks gestation, and universal treatment with IV antibiotics (usually penicillin or ampicillin, or an alternative for penicillin-allergic women) throughout labor for women who test positive for GBS during pregnancy.

An alternative treatment to IV antibiotics that has been investigated in Europe and developing countries, but is not employed in the United States other than by homebirth midwives, is the use of chlorhexidine, a topical antiseptic solution that kills GBS. While some studies have shown that chlorhexidine does reduce neonatal colonization and infection compared with conventional antibiotic treatment, other studies have shown only a reduction in colonization but not in the rates of early onset GBS infection. More investigation of this cost effective, easy to use option is needed to determine whether this is a consistently effective alternative to routine IV prophylaxis for neonatal GBS infection. It is also unlikely to help in the prevention of infection when there is prolonged rupture of membranes, as it can’t keep bacteria from ascending. Hibiclens, which contains chlorhexidine, is the form that is typically used by midwives in the US.

Keep in mind that Hibiclens and chlorhexidine will also wipe out healthy vaginal flora, likely for many hours after each application, and not just selectively eliminate the GBS, so while you might avoid the antibiotic, you may be defeating the purpose of avoiding it without a better outcome, which is keeping the vaginal flora healthy so baby gets optimally colonized with mom’s flora at birth.

What if I Test Positive But a Later Test Comes Back Negative?

When it comes to GBS infection in pregnancy, once you test positive, even if you later test negative in the same pregnancy, you are still considered to be positive and antibiotic treatment is recommended by the CDC (note if you are negative in this pregnancy, but were positive in a previous pregnancy, you do not require antibiotics, unless your previous baby developed GBS infection, in which case antibiotics are considered appropriate). So while you might use natural approaches to try to reduce your colonization, if you are having your baby in a hospital or birthing center, the standard protocol would still be to administer antibiotics.

Can I Decline Antibiotics & What are the Risks of Doing So?

You do have the right to decline antibiotic prophylaxis in labor. If you decline, while there is an overall very low likelihood (2-3% chance) that your baby will develop early onset GBS infection; the risk is about double than if you did accept the antibiotic.

I have also seen a few situations get legally complicated, including social work being called to assess for negligence and child abuse when parents declined antibiotic prophylaxis in labor, and one case where the parents were forced to let the baby be given the antibiotic after birth, since mom had declined to receive the antibiotic in labor, even though the baby had no signs of infection.. While hopefully you’d not be met by that vitriolic a response by your care provider or hospital risk management team, having the discussion with your obstetrician, family doctor, or midwife at the time of the positive test result, rather than during labor, is strongly advised so you don’t face any surprises.

It’s important to be fully aware of the risks of GBS before choosing to pass on the antibiotic prophylaxis. There is also no natural substitute for antibiotics in women who are GBS positive, with signs of infection and prolonged rupture of membranes (>24 hours rupture), and all newborns exhibiting signs of GBS infection must receive immediate and aggressive antibiotic therapy. Keep in mind that if you decline in labor, and are GBS positive, you may be pressured to give your baby antibiotics after birth.

Can a Healthy Microbiome Protect Against GBS?

A healthy vaginal flora and healthy gut microbiome can reduce the likelihood of GBS colonization, and as a result, reduce the likelihood of infection transmission to baby.Lactobacillus has been show to inhibit the attachment of GBS and other harmful bacteria to the vaginal lining. Lactobacillus reuteri and Lactobacillus rhamnosis are species known to be especially helpful for supporting normal vaginal flora. I recommend 1-2 capsules of a probiotic daily during pregnancy, and especially in the 3rd trimester, not just to help prevent GBS, but also because it has been shown to reduce the risk of atopic conditions in kids (allergies, eczema, asthma) when taken by mom in the last third of the pregnancy.

When there is GBS colonization (a positive test), a history of GBS in a previous pregnancy, or a history of frequent urinary tract, yeast, or other vaginal infections, I also recommend use of a vaginal probiotic – simply insert a capsule of probiotic containing the above species, or work with a functional medicine doctor or naturopathic doctor who can help you to get a compounded vaginal gel with these species. Live active culture yogurt can also be inserted vaginally, using your clean fingers, daily. I recommend my patients do this at the start of a shower several times each week starting the third trimester, then simply rinse it off at the end of the shower and put on a panty liner (organic is best!) to catch what drips out. Interestingly, one study found that pads soaked with probiotic helped to reduce vaginal GBS.

Are There Natural Things I Can Do To Test Negative for GBS During Pregnancy? Can GBS Colonization Be Prevented & Treated Naturally?

Avoiding any risk factors you can, and nurturing a healthy gut microbiome and vaginal flora is your best prevention against GBS in pregnancy. Herbal suppositories may be beneficial – clinically I have found them to be – but while the suppositories themselves are safe and the herbs have shown in vivo effectiveness against many organisms, including GBS, there is only a sparse amount of scientific evidence supporting their effectiveness in the human body.

This is the protocol I use in my practice to reduce GBS colonization. It is not, however, meant to be a substitute for medical treatment if you do test positive for GBS in spite of treatment prior to the test, and is not meant to treat GBS in lieu of antibiotics in labor if you had a positive test prior to starting treatment, though it is reasonable to use to attempt to reduce colonization prior to birth.

For women choosing to birth at home, the use of IV antibiotics in labor may not be a realistic option because in many states, home birth midwives do not administer IV medications. Home birth midwives in this situation, therefore, often use a risk- assessment mode, transporting to the hospital for IV antibiotic should indications arise, including rupture of membranes longer than 18-24 hours (length of time varies with the protocol of different medical and midwifery communities) or any signs of infection.

Natural GBS Prevention

These are the steps I take in my practice to help women prevent or reduce GBS colonization.

Eliminate sugar, most fruit, and all junk food completely from the diet to help normalize the vaginal pH; this improves the growth medium for healthy vaginal flora

Take a prenatal vitamin to insure that you are getting all the nutrients you need, especially zinc, vitamin D, vitamin A, and vitamin C, to keep your immunity boosted

Insert either 1 clove (not a bulb, just a clove!) of carefully peeled garlic into the vagina each night, using your finger to push it in about 2-3 inches (remove with your finger the next day), or if you’re adventurous and willing to prepare this, use the following herbal suppository nightly for 3 weeks to reduce local colonization and heal vaginal tissue if there is any inflammation or irritation. In my practice I alternate as follows: three nights of the suppository, one night of garlic, two nights of probiotic, one night off; repeat for three weeks.

Healing Vaginal Suppository

To prepare:

Melt ¼ cup of coconut oil and ¼ cup of cocoa butter in a small saucepan.

Turn off the heat and add:

2 TBS calendula oil

1/2 tsp. of thyme or oregano essential oil

2 TBS goldenseal powder

1 TBS myrrh powder

Pour the warm, slightly thick liquid into a suppository mold (you can order affordable silicon ones online). Put the whole mold into the fridge and let the suppositories harden for about an hour, then pop them out of the mold and store in the fridge in a container.

Suppository molds can easily be prepared at home by using aluminum foil that has been folded several times lengthwise, and then widthwise, to form a trough approximately 8 inches in length and 1/2 inch in width. This mixture is then poured into the mold, refrigerated to harden, cut into pieces the size of the patient’s pinky finger, and inserted as needed.

Wear a light menstrual pad each night to protect underwear and bedding, as the oil and goldenseal powders can stain as the suppository melts. These herbal products can be purchased from Mountain Rose Herbs online.

One Final Word…

While we do need to be concerned about the health of our babies’ microbiomes, and it’s not ideal to give our babies an antibiotic as part of the their welcome to the world, antibiotics do play a role in preventing serious infections, and prevention in this case can mean preventing drastic consequences. Unless there is a prolonged course of antibiotics in the newborn, any damage can usually be repaired by giving baby a probiotic for the first 6 months after birth. In babies born by cesarean, where there is also antibiotic exposure through mom, a probiotic given to baby has been shown to prevent atopic conditions.

It’s important to make the decision that you are most comfortable living with and that is best for your baby, and not feel swayed by any pressure to avoid an antibiotic because of the desire to go “all natural.” There’s an appropriate time and place for most things, and while right now the jury is still out on the severity of the implications of giving antibiotics to newborns via mom, or directly, it would not be an inappropriate choice at all to decide to use an antibiotic in labor.

Have questions? I bet you do! Post them in the comments section below and I will do my best to answer as many as I can.

Wishing you a healthy pregnancy, birth, and baby,

P.S. I’ve received a number of requests from readers asking if they could use this article as a handout for their clients. So I created a PDF for you. You can download a copyHERE.

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113 Comment

Charmaine Koehler-Lodge

This is a wonderful article that came too late for my daughter's baby who was born last February. My daughter, who tested positive for GBS, was given an iv antibiotic while in labor. She has been struggling with a persistent yeast infection in her daughter ever since. She has been trying to treat it with probiotics and other natural remedies to no avail. Do you have a protocol that you can recommend to her?

aviva

Silvana

Thank you for your article. I tested GBS positive at 8 weeks (now 18 weeks) and am struggling with the decision of what to do about antibiotics in labor. Am I reading correctly that the chances of my baby having a GBS infection is 2-3% if a decline antibiotics vs. 1-1.5% if I accept antibiotics? Also, is there any research to show the difference in risk with vs. without antibiotics if there are other factors involved such as PROM? I had PROM at 36 weeks with my first so am keeping this possibility, and what I'd feel comfortable doing in relation to it, in mind. Thank you for your help!

aviva

Hi Silvana, From my training and research, women who test positive in early pregnancy have a higher rate of having a baby with GBS infection; the 2-3% is severe infection in those who get colonized (50% of babies), so half of that for all babies. But yes, the rate is much less if antibiotics are taken. PROM itself is a higher risk for having GBS colonization, and infection, so yes, the need for antibiotics is even higher in that case again... A lot to think about, I know! Keep in mind that the risks are overall low, but also the risks of causing some terrible damage to your baby from the antibiotic is also low! :)

Linda Honey

Ashley

thank you so much for the information. I am GBS positive and am having my first baby sometime in December. Move decided that I will take the antibiotic, so am now looking for information about administering probiotics to my baby afterward, and also how I can reduce my own risk of yeast infection, etc afterward. Do you have any recommendations?

aviva

Lily

Thank you for your informative and balanced approach! I did test positive and, while I avoid antibiotics and opt for colloidal silver/garlic/oil of oregano for average infections, I did not want to take any chances and was perfectly fine w/ receiving the prescribed antibiotics. Afterwards, I re-plenished with intensive pro-biotic use (for myself AND baby) to re-balance.

aviva

Paula

Hi Aviva! Your suppository recipe is fabulous. When do you recommend doing this? The reason I ask is that I could see women using this before testing, which could result in a false negative. So, to be clear, do you recommend this at the start of the 3rd trimester? Second? Or is it specifically designed for 3 weeks prior to GBS testing?
I've also heard another remedy for overall vaginal health (including protection of the microbiome) is vaginal steams, which can also be done in the 3rd trimester. I'd love to know your thoughts on that.
Thanks!
Paula

aviva

Hi Paula,
I don't know that it would result in a false negative, though I've wondered, so what I do if mom pretreats and has a negative is test again a couple of weeks later if in doubt. I now thing negative is negative and in such cases just keep my mind on a risk management approach as an intermediary plan. Aviva

aviva

Jan

Aviva, I'm a homebirth midwife that deals with this issue all the time too. I used to use the chlorhexidine protocol, but after considering the microbiome more seriously, feel uncomfortable using that strong antibacterial soap and potentially disrupting the beneficial bacteria that the baby needs. I don't have the option of running IV abx for my clients in the out-of-hospital setting (and lots of them wouldn't want it anyway.) Besides offering a similar prenatal protocol of probiotics, immune system boosters, and vaginal suppositories, I have started carrying colloidal silver gel and spray with me to births. This particular product by ACS claims that it won't disrupt the beneficial bacteria but will have an effect against the harmful ones. I don't know exactly how that is possible ..... but it's an option I feel more comfortable with. Just thought I'd share.

Dana

Hi Aviva,
Again, an article I really liked, well explained and well documented. Thank you!
I've tested positive to GBS and chose to have the antibiotic. While I knew that it was risky for my baby's microbiome, I thought that the benefit of having the antibiotic was outweighing the risk. I was just wondering what kind of probiotic you recommend for infants. Is there a particular brand you would recommend?
Cordially,
Dana.

aviva

Hi Diana,
A good and reasonable choice indeed! For the infant probiotic I recommend Klaire Therbiotic Infant because it contains the Lactobacillus and Bifido strains, but other brands that contain these and are made for infants should also be fine. Warmly, Aviva

Dana

Amity

Hi Aviva,
I too had an antibiotic during labor for GBS and my daughter has eczema/food allergies which we started to realize around 4 months old. She's now 21 months old. Is there a good probiotic for her age group that you recommend? She's allergic to dairy but does eat coconut yogurt occasionally. Can you add liquid probiotic into recipes or will the probiotics be killed with heat?
Thank you.
Amity

aviva

Vicky Miller

Thank you for this very balanced article on GBS colonization and treatment in labor! I test all of my clients. Many prefer not to use antibiotics although I do offer to administer them and let them know it is the safest option. The back up OB prescribes them. I am sending the link to your blog to all of my clients. BTW I live and have a homebirth practice in Costa Rica. Universal GBS testing is not standard of care here and there are not good protocols in place to deal with infants of GBS positive mothers, treated or not!

Feenanda

aviva

Kalanete

Aviva, what product do you recommend for a probiotic for the newborn? I was recently asked this by a mom who had given birth by cesarean and was not sure what to recommend for correct dosing of a newborn. Thanks for your input.

aviva

Anna Kauffman

I tested positive for Group B Strep for my first born and was put on antibiotics during labor. It was a hard labor and the baby was born not doing well. It took her a week to give her first good cry. She's 10 and still has a lot of issues. I don't blame all her issues on those antibiotics, but I am sure they didn't help her. When I again tested positive for Group B Strep four weeks before the due date of my fourth child, I decided to try a few things and then retest. My midwife gave me permission but warned me that others had tried things and no one really succeeded. My husband grows our own heirloom garlic, I took a clove and pressed it with a knife to activate the medicinal properties. I inserted the flattened garlic into my vagina and fished it out after 24 hours. I repeated that every day with a fresh garlic clove and when I retested for Group B Strep a week later, everything was clear! Not only was everything clear, but I could tell the vaginal fluid was healthier. In fact, when I gave birth to to my daughter, she was the healthiest infant I have had! I would love to see a midwife do a research on this method of treatment for Group Strep B!

aviva

Diana

Hello Aviva,
Great article! I like the diplomatic tone with which you handle the sometimes overly natural oriented moms-to-be. Indeed getting antibiotics to prevent a severe illness in the baby is sometimes the best way to go.
My question is: what if I test GBS positive and accept the antibiotics during my labour, what kind of probiotics would you recommend for the baby? Same one as for adults? Different one?
Aldo fir newborn babies, any ideas on the best brand of vitamin D drops? So far in pharmacies I have seen only horrible alternatives with plenty of added chemicals and did not buy any yet.
Thanks for for great blog Aviva, it is really useful!
Cheers,
Diana

aviva

susan bradford

Hello Aviva, Thank you for this very complete and updated information on GBS+. I will be using it to inform my holistic childbirth preparation classes. I would like to hear what you have to say about using the C Reactive Protein test for newborns born of GBS+ mothers instead of using IV Antibiotics during labor. I understand that babies who are born of GBS+ mamas are tested after birth even tho they have received antibiotics during labor and are given more antibiotics then if they are positive for GBS. Why not just test all the babies of GBS +mamas soon after birth to decide whether to use antibiotics or not?

aviva

Probably because it's hard to tell the difference between infection and colonization - until infection appears which can happen really fast and furious in a newborn. So prevention trumps identification and treatment.... But great Q.

Alyssa

aviva

Yes, the probiotic capsule does dissolve. One can get a little irritated from the garlic if not peeled carefully. Never heard of any adverse reaction from yogurt. Anyone of course can react to anything, but in my 35 years of experience I've not heard of any problems with these.

aviva

Lisa Stachura

Thanks for all of the really great info!! I did the garlic CLOVE and yogurt inserts on my last pregnancy and intend to do them again for this one. This article was a great reminder and I love the simple recipe for the homemade suppositories. I will try those as well. ❤️

Gumboots

Thank you so much! Well researched, succinct and easy to understand. Your balanced approach is much appreciated, and it is so helpful to have some context and clarification of risk factors in this issue.

Al

Hello, thank you for your article, you recommend using the IV probiotic but also imply there is some infection that can occur before birth begins. Can this bacteria cross to the naby before a broken membrane? Should a mother take oral antibiotics leading up to pregnancy to prevent this early onset?

aviva

Antibiotics are only indicated if the mom is GBS positive, or unknown status with risk factors as I mention in the article. It is not too likely to cross a healthy intact membrane and I've not heard of this happening before labor.

April

Ashley

Prenatal Onset GBS is a real and fatal type of GBS that can and does occur. My daughter Gwyneth was born stillborn this September on my due date from GBS in Utero which caused pneumonia. My life will never be the same. I was never in labor, did not have my water broken, did not have a fever, did not have any signs of infection, etc, except for testing positive for GBS 3 weeks prior at 37 weeks. GBS bacteria has a mechanism that "spits" out a chemical which can make holes in an intact placenta and amniotic sac. I don't mean to scare people, but I do like to spread the word so that mothers like me know how deadly GBS truly is. I am now 6 weeks pregnant again and still testing positive for GBS. I am going to be following a lot of the recommendations here and have been since September. I am hoping to be negative in the next few months and eliminate the risk of death for my next child.

Ashley

And just wanted to add thank you so much Aviva for supplying this type of natural information to mothers like us. Even after my daughter's death, none of my doctors or GBS specialists can give me an answer on how to eradicate this bacteria from my body - without taking antibiotics throughout my pregnancy or do nothing. It makes sense if it originates in the gut, that it is effected by what you put in your gut. I have been at this probiotic/fermented diet (not garlic suppositories yet but will start now) for 4 months and still positive. I believe it takes time to change your gut and vaginal bacteria, but I am confident I can beat this bacteria this time around. I truly appreciate your information on how to do so.

Vittoria

Ashley - thank you so much for sharing your story. This really hammers home the risks of GBS. I can't even imagine how hard that must have been, and still must be. My heart goes out to you and your partner and I am sending lots of love and energy your way for a healthy pregnancy this time. Much, much love to you.

Christy

I just want to mention that as a midwife I've seen a drastic increase in the number of women testing positive for GBS in my practice in the last several months. The lab we use upgraded their testing to a newer form of testing for GBS and we're seeing a 50-90% GBS positive rate. Of course that doesn't mean we see more babies getting sick with GBS, but it does mean more women wrestling through the issue of receiving IV antibiotics in labor or not.

Julie

Hi Aviva,
Thank you so much for your very interesting article on GBS. I don't have a question but I do have a comment. I had 3 daughters and on my third pregnancy, I had the GBS testing and was found positive. Neither of my first two pregnancies were problematic. My first pregnancy my membranes had to be ruptured by my doctor about a half hour prior to my delivery and my second pregnancy they ruptured spontaneously at 2 am and the baby was born by about 6 am. I had a midwife for my 3rd pregnancy and she recommended IV antibiotics for me while in labour to protect my baby, I agreed although I knew I was likely low risk for complications. The way she explained it and pressured me to have the IV antibiotics I would have felt so guilty if anything had happened to my baby. The frustrating thing was my midwife did a stretch and sweep and my 3rd baby was delivered before the IV antibiotics could even kick in. My midwife even said to me while I was in transitional labour, "Can't you hold on to give the antibiotics time to work?". It was absurd. My baby was fine but would have been without the antibiotics as well. Looking back I often think I should not have had the IV antibiotics as I wasn't in a high risk group. I hated having the IV, and pushing the IV pole around the L&D ward as I walked through my contractions, only to find out the delivery occurred too fast to allow the antibiotics to work. I think high risk patients should definitely have IV antibiotics but I still think those who are low risk should not be guilted into having IV antibiotics when the risks are so low. Just an opinion but thought readers of your article might be interested in my story as well!

Rowen

April

Aviva, thank you so much for continuing to share your knowledge so freely.
Can you please comment on whether the insertion of garlic, or the suppository you describe, could have a negative impact on the vaginal flora that is so important for colonizing the baby at birth?
I know of women using garlic as a preventative measure, and I worry about the risk to the flora that the baby needs.

aviva

Hi April, I haven't seen any studies that look that the changes in healthy flora when these supplements are used, but they target the harmful, not beneficial organisms overall, so shouldn't be a problem especially when the diet is healthy and a probiotic or lactofermented foods are being taken.

Kristen

I was wondering how long the IV antibiotic has to be in the system before the birth to be effective. I tested positive with my third, and I had the IV. With my fourth, I don't think I was positive, but I was barely at the hospital an hour before delivering. There was not much time to have had an antibiotic especially since I am allergic to penicillin. As I enter my fifth pregnancy, I am researching all over again. Thank you for this article.

aviva

Karen

Great article! I'm curious about the risk of other nosocomial infections - eg MRSA - following antibiotic use. Thanks also for pointing out that most late-onset GBS infections are carried by hospital workers' hands. Another reason to insist that hospital personnel handle baby as little as possible and that hands and equipment are properly cleaned.

aviva

Erica

Hi Aviva,
I tested + for GBS and received 3 rounds of Ampicillin during labor. My baby is now 4 and a 1/2 months old and I am just now seeing this helpful article. Is it too late now to treat my baby with probiotics?
Thanks!

aviva

Christina

What is your list of fruit you recommend if most fruit is to be avoided? I don't eat processed anything and fruit is the only sweet thing I eat. I am due this December and am working on my goal of controlling this worry by diet, probiotic and maintaining an active lifestyle. Thanks for elaborating on this.

aviva

Linda

I have a comment, wouldn't it be wise for women to include fermented foods and drinks into their diet before trying to conceive and continuing throughout pregnancy and for the rest of their life?
Great article!

aviva

angelica

If a vaginal birth is so important because of the friendly flora that a child receives during birth, I don't understand how antibiotics could be non-detrimental. I just heard a study that if this protocol is followed so much of the bacteria is killed that some of the beneficial strains can never be redeemed. Pretty scary stat with how often this procedure is being done. This bacteria is very common and our daughters MD said that he doesn't recommend the antibiotics... our daughter tested positive and then we did a protocol with silver and then retested. The second test was negative.. no antibiotics required. Another very personal decision...

Elle

Hi Angelica,
I hope you get this! I'm pregnant with my third child, was told I tested negative, but then today was told they made a mistake and I'm actually positive. I'm very distraught as I tested positive with my first, did antibiotics, and he's got thrush and staph shortly after birth. A doctor I was seeing in addition to my OB during my second pregnancy recommended I cleanse with colloidal silver and squirt around the walls of my vagina as well just before the test. I did, and it was negative. I did the same thing this time, but with a different brand of colloidal silver. I'm very confused since I was told in one breath I was negative, then a week later, told they made a mistake and I'm positive. I was also told I HAD to get the antibiotics, even if I tested negative in a follow up test. My question to you, what was the silver protocol your daughter followed? Thank you!

Rebecca

Thanks for this article! I'm 39 weeks now, have tested GBS positive and have decided to go with the antibiotics at my planned home birth. I haven't made a decision about what I'd like to do with the placenta yet... Do you know if taking the antibiotics during labor effects the placenta in such a way that it shouldn't be ingested? Thanks!

Lisa

Andrea

Hi Aviva,
Thank you for your article. I know that Midwifery Today had an article on GBS and water birth. It showed having a water birth worked better to prevent GBS in baby, then antibiotics. I'm just curious as to your thoughts on that.
Thanks

aviva

Wow- I really highly doubt that this is effective in preventing GBS infection in baby, or has been scientifically proven -- but I'd be interested in seeing that data. I wouldn't use water birth as a preventative, though,personally...

Jessica

Hello,
Thank you for the great article and feedback to questions. If a little garlic gets "lost" in the vagina, will it find its way out eventually? I assume so, but just want to be sure. Also, should garlic only be used once a week? Thank you!

Marissa

Hi Aviva! I received your newsletter email at the same time that my midwife's office was calling to say that I tested positive for GBS...for the second time during this pregnancy! I am 21 weeks pregnant and just started my second round of ampicillin. The first positive test was at 12 weeks and I took a round of the ampicillin then. I usually never use medicine so this hasn't been easy. My first son Harry is 16 months old. I had no issues during that pregnancy. I started battling mild yeast infections shortly after Harry's birth. I stopped nursing him when he was about 15 months. I take a daily probiotic and eat yogurt every day. I was too nervous to try the garlic but after reading this article I am ready to try you're recommended routine. Thank you!
I was also just told that I have placenta previa (complete coverage). I am going to start acupuncture but am wondering if you know of any other natural options to try and "help" my placenta move away from my cervix. I would really like to avoid a cesarean and any accompanying complications. I am told that with the "complete coverage" there is not a good chance of things being corrected. ANY advice is appreciated. Thank you in advance for taking the time to read this lengthy comment.
Much love,
Marissa

Rebecca

Hi,
I am about to have my second girl in about 3 weeks and the first pregnancy I was negative for GBS. I always go through a birthing center and on this pregnancy I was tested positive at around 12 weeks for GBS in my urine. I didn't really realize they tested that early. So I asked to be tested again at 36 weeks and my results came back negative. When I was tested positive at 12 weeks they had me take antibiotics until I was negative again and that took about 2 rounds of antibiotics. I am not a fan of taking any type of medication. I have done a tone of research on this topic and I keep feeling like I shouldn't take the antibiotic. This is such a hard decision and a lot of people recommend taking the antibiotics. Just wanted to know your opinion on it. I just get a little confused because I was positive early on but now I am negative.

Elizabeth

It really frustrates me that the laboratory will only give you a positive or negative test result. I want to know exactly how many colonies were present so that I can make a better educated decision about what to do. For example, in the case of a positive result, if the number of colonies is significantly greater than the cut off for a +/- result, I might choose treatment; whereas, if the results show barely enough colonies to warrant a positive result, I might choose to forego treatment. Knowledge is power and it is wrong for laboratories to withhold this knowledge.

susan bradford

Hi Aviva, I wrote a question in your comment box yesterday and went back today to see if you had answered it but i don't see my question here now. Not sure what happened but I am really interested in knowing what your thoughts are so I will write it again.
I want to hear what you have to say about the protocol of using the C Reactive Protein test for the newborns of mama's who are GBS+ in lieu of prophylactic IV antibiotics during labor. Then only babies that test positive to that test would be treated with antibiotics. Could you please write your response to this protocol?

aviva

Hi Susan,
Don't know what happened to your Q, which is a great one. According to the CDC, measuring acute phase reactants is not considered part of the full diagnostic evaluation of infants with suspected sepsis. The sensitivity and specificity of these tests are too low in infants for them to be consistently useful in decisions to initiate treatment for suspected sepsis. However, some experts have argued that acute phase reactants may be useful in decisions to stop antibiotic treatment for suspected cases of sepsis.The problem is that it's really only meaningful 8-24 hrs after birth, and by then, baby could be on the way to full blown sepsis. So unless that test becomes more sensitive early on, I don't think it's a sub for prophylaxis. Best, Aviva

Krishna

Amy

I tested positive for GBS at 37wks. Antibiotics were administered during labour. I had a beautiful thriving baby boy. At 3mos he became ill with GBS. I noticed it around 10am one morning. He wasn't as hungry as normal but wasn't fevered. By mid afternoon he still wasn't fevered but was sleepy. I took him to the ER, by this time he was already septic. I'm told that minutes more and the outcome could have been very different. We spent 2 weeks in the hospital undergoing bone scans, spinal taps and other tests. Today he is a bright, fun and wonderful 5 year old. The percentage of your baby having GBS might be low... but it's not impossible. Be informed. Be proactive. Don't take chances.

Jess

Memrie

I was +GBS with my 6th child. Had PROM and she came so fast I never made it out of the house. Sadly we were part of the low percentage that got sick. I was very sick and she almost died going septic. She was the only child i was ever positive with out of 7. She has learning disabilities and several health problems. I only share this experience because I never believed it would happen to me. I just knew she would be fine and it was not until she stopped breathing before i even let her go to the nursery. And I am a believer in informed decisions, but if my experience can save just one baby from this I will share it. Yes it happened to us.

Ktmae

Hi,
Thank you for such a great article! I tested positive for GBS early in my last pregnancy and received ABX while in labor. I am expecting again and GBS was found in my urine sample at 8wks. My question is: should I plan on the ABX again during labor or if I do the routine suggested and test negative at the end of my pregnancy, is it really okay to forgo the ABX while in labor? Meaning, am I really negative?
Thanks,
KT

aviva

Ashley A

Hi Aviva!
Thank you for the breakdown in this post. It really helped me better understand GBS. I tested positive for it in my first pregnancy even while taking a probiotic. I'm not pregnant with #2 and due in May. I'd really love to avoid GBS again especially since I'm trying for a vbac. I'd love to start your recommended probiotics now but they're on the pricier side. Would you say 30 weeks is the suggested time frame to start them if I don't start them now?

Rhoda Baughman CPM

Hello Aviva!
I have a question regarding your herbal suppository. The amounts you list here, are they to make enough for one 3 week treatment span? Or will this make many suppositories? I just want to make sure that I'm not 'stretching' the herbs to thin. Would love your input.
Much love,
Rhoda Baughman CPM

aviva

Sydney

I am 38 1/2 weeks pregnant with my first child and was tested positive for GBS. I have been battling with the decision to go to a hospital and receive treatment or continue my plans of a home birth with my midwife and birthing team. It's a very tough decision. My boyfriend and I really want to do our home birth, but the fear of our son catching GBS during birth is a lot for me to wrap my mind around. I just don't really know what to do. Your article was very helpful and informative. I did learn that either way the baby can have health problems....antibiotics or not. I really need help making an informed decision. Are there any statistics that I can research? Any further info that could help me make a decision? I'm reaching the end and I could really use all the info I can get to make an informed decision. I really want to do the birth at home like we planned.

Poetess

I tested positive for a uti in November caused by gbs. Colonization was 100,000 so I took Macrobid. I was told yesterday I have another uti caused by gbs with the same colonization number. Now my ob prescribed Clindamycin and I am too scared to take it, but I want to get rid of or at least lower the colony. How can I do this naturally? I would appreciate any advice, Thanks!

aviva

Dear J,
Thank you for writing to me and valuing my opinion with your important question. I would so love to be able to answer, and in fact, this is something I address with women in my practice and have for years, but because this is a complex pregnancy situation, I can do much better justice to health questions in an appointment...and just can't electronically.
To become a patient in my medical practice, Thrive Health, you can find out more here: http://avivaromm.wpengine.com/health-consultations
With warmest wishes,
Aviva Romm

Ashley

Hi! Thank you so much for this balanced article. I tested positive at 36 weeks. I've never had antibiotics in my life, and was hoping labor wouldn't be the first time, So I started taking a probiotic, eating sauerkraut, taking vitamin c, as well as elimating all sugar, dairy, and white flour from my diet. I retested at 38 weeks (just this week) and the teat is now negative. I'm still not sure if I should take the antibiotics or not. The doctor said gbs can come back, so they still recommend that I take it. They also said it could be present in another part of my body?
My question is, if I keep up this strict regimen through labor, what are the odds that it could come back?

KDS

Knowing that the risk for EOBGS is 2-3% w/o ABX and roughly 1-1.5% with, but also that the risk is much higher with delivery at <37 wk, am I correct in assuming a large chunk of that 2-3% is for preterm babies? I'm interested in comparison for the risk vs universal approach in term infants w/o PROM. I'm 37 wks GBS+ w/ my 3rd, my first 2 being born within 30 min of water breaking. With my 2nd (born at 39w6d), I tested + in urine in 1st trimester, opted for ABX, but my entire labor was less than 1 hour, and my home birth midwife never arrived in time to administer ABX. My daughter was born quickly and perfectly healthy. I am considering the risk-based approach with this home birth but am having trouble finding hard #s that pertain to my situation.

Kelsey

Hi there! Thanks for this fantastic article. I was GBS - first baby, but GBS+ last pregnancy and the antibiotic's triggered IBS for me and a resistant thrush that caused me to abandon breastfeeding by 6months :(. I'm in the second trimester with my third and taking garlic and vit c and natures bounty 10 probiotic. It has the L. Rhamnosis but not Reuteri... Can you recommend a better brand to use? There are so many out there and some are so pricey... it's overwhelming!
A friend of mine in a similar situation and was told even if she tests negative she would still get antibiotic's since she was positive last pregnancy. (No complications) Isn't that unecessary? She's afraid to refuse but her son developed a lot of GI issues and dietary allergies that she suspects was from the antibiotic's last time. Thanks for any advice!

Mel

This is a wonderful balanced article. I wish I'd had this while pregnant. I first went to a doctors office and got labs done before switching to a home birth midwife. My test at 10 weeks was positive. I got on probiotics, did the garlic insertion (you can thread a string through the clove to make it easier to remove), tea tree oil tampons, etc. and was negative at 36 weeks. I had to transfer to the hospital and as soon as they pulled up that 10 week positive after my daughter was born the hospital staff freaked out. I mean i was treated like a villain. One doctor told me what I did (not getting antibiotics) was akin to her letting her own daughter go out and get shot. I was bullied and gossiped about. It was devastating. I've never cried so hard in my life. They kept my daughter and extra week on harsh antibiotics and traveling to and from the hospital with a broken tailbone was horrible. As soon as she got home I got her on probiotics. I really wish i could do it over again. I wish I'd done it their way to just avoid the emotional trauma. I had no clue it was such an issue. My sister in law in England and another friend that had a home birth hadn't even heard of GBS. It's a confusing topic but the results can be devastating. Please read this and consider your treatment for refusing to do what the hospital wants or if you transfer to a hospital.

Laura

Hello, I was diagnosed with GBS in 1999 when my first daughter was born. I was administred an antibotic during vagina delivery. She was full term and weighed 6.1 lbs. My daughter is now 17 and strugges with urinary and vagina odor problems. I had my second daughter in 2002 c-section due to being breech. She was full term and weighed 6.3 lbs. She at age 2 got really sick we thought she had rotavirus but it was negative. After that she rapidly started gaining weigth. She is now 13 and is very obese. I believe it their issues are caused by my GBS. Do you have any suggestions??

Megan Liebmann

Hi Laura,
Thank you for reaching out and I am sorry to hear your daughters are struggling. As mamas seeing our children struggle is so incredibly hard. Honestly the answer goes beyond the scope of what we can provide in a blog comment, but, a good place to start is to find a functional doctor in your community or a functional nutritionist. We recommend looking on the website of the Institute for Functional Medicine (https://www.functionalmedicine.org/) for a practitioner. There are so many steps that you can take, it just takes a bit a guidance.
I hope this helps.
Warm wishes,
Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

Kristin

Hi Aviva,
Im 9 weeks pregant and Im currently on antibiotics as the dr said i had a UTI, due to the bacteria GBS. I also tested positive to this at 37 weeks with my first born and had the antibioctics during labour which was a quick 4 hour birth' which i dont think that was enough time for it to take affect.
Since then 2 years later i was dianosed with leaky gut, and i have been taking polybac 8, eating fermented foods, apple cidar vinegar, slippery elm and hemp seed oil. Would you suggest to keep at this during antibioctics and after? And is there anything else you can suggest to help undo any damage caused by the antibioctics? Thanks

aviva

Katherine Waliser

Loved your article! Do you have a specific brand of probiotic that you recommend for newborns after the mother has been on IV antibiotics due to Group B Strep? I'm having trouble finding much online along the lines of specific recommendations.
Thank you!

Megan Liebmann

Jacqueline Phillips

H Aviva! Thanks so much for the article. There was a woman who posted earlier saying she had a stillbirth due to Group B Strep. This makes me nervous because I tested positive for Group B in my first trimester (even though my number was really low) and again now at 36 weeks. I have been taking Fem Dophilus and Klaire Labs Probiotic for Infants (the lady at our local health food store said I could start taking it before baby arrives). Should I also be doing the garlic and a vaginal probiotic? I will be taking the antibiotics as well. Thanks so much!

Aviva

Hi Jacqueline, Yes this would be scary to read - sorry I didn't see your comment sooner. GBS would be a rare cause of stillbirth and is not a usual outcome unless baby got infected early in a long labor, for example, which would be prevented only by being on antibiotics from super early on in labor, which isn't even the typical medical protocol in most cases. Using the probiotic is a great idea; you can do the other herbal approaches, but this wouldn't have been enough to prevent the other woman's situation...Do chat with your midwife or doc so she/he is aware of your fears and can help reassure you as again, this is an unusual outcome not typically due to usual levels of GBS infection, and especially if antibiotics are used in labor. Wishing you the happiest best rest of your pregnancy, and a wonderful birth and new momma experience!

May

Aviva Romm

Since we don't know how long labor we'll be, they are still given in labor - but if baby hasn't been exposed for the full length of time, a watch and wait approach with baby is appropriate and direct treatment for baby if needed is recommended.

E.G.

Hi,
Great, great article. I tapped into your recommendations for my last pregnancy and am trying preventative measures this time around. Last time, I started the garlic clove at the end of week 37. After one night I read somewhere the clove needed to be bruised or scored to have affect. So I bruised it and woke up the next day with cramping. I tried again the next night and had cramping and appeared to lose some mucous plug. Then after a day went into labor and had my baby 2 weeks early. I can't help but feel they were related. Is it possible the garlic irritated things or just odd coincidence that all happened back to back? I want to be proactive this time but now I am scared of the garlic!

Aviva Romm

I never bruise the clove - that can cause irritation and burning - but enough to cause labor onset? Not too likely...But for you, maybe avoid the garlic - and definitely don't bruise it! GBS itself, however, can cause early labor. Best wishes!